Stavrakis Alexandra I, Khoshbin Amir, Joseph Amethia, Lee Lily Y, Bostrom Mathias P, Westrich Geoffrey H, McLawhorn Alexander S
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA.
Division of Orthopaedic Surgery, University of Toronto, Toronto, ON Canada.
HSS J. 2020 Dec;16(Suppl 2):394-399. doi: 10.1007/s11420-020-09764-6. Epub 2020 Aug 4.
Groin pain is a common long-term complication of total hip arthroplasty (THA). Femoral head size has been proposed as one of the primary causes. The implants used in dual mobility (DM) THA have large outer-bearing articulations, which could increase the risk of post-operative groin pain. Hip resurfacing (HR), too, has been shown to be associated with a risk of groin pain.
QUESTIONS/PURPOSES: The goals of this study were to compare the incidence of groin pain at 1 year after hip arthroplasty in patients with different femoral head diameters and in patients undergoing conventional THA, DM THA, and HR.
After combing an institutional registry for all patients who had undergone THA or HR for primary hip osteoarthritis, we included 3193 patients in the analysis; 2008 underwent conventional THA, 416 underwent DM THA, and 769 underwent HR. We used logistic regression modeling to analyze the relation of groin pain at 1 year after surgery to patient demographics and clinical characteristics, including age, sex, body mass index (BMI), University of California at Los Angeles activity score at 1 year after surgery, bearing couple, and the ratio of acetabular diameter to femoral head diameter. We also measured cup inclination and anteversion in a subset of patients with and without groin pain at 1 year to assess whether pain could be related to implant position.
Overall, 8.7% of patients reported groin pain at 1 year. Patients with groin pain were younger and had lower BMIs. There were increased odds of groin pain with a greater cup-to-head ratio, although DM implants, interestingly, were not significantly associated with groin pain; this may be attributable to so much of their movement taking place inside the implant. Subgroup analysis measuring cup inclination and anteversion showed no difference in cup position between patients with and without pain.
In this population of hip arthroplasty patients, the incidence of groin pain 1 year after surgery did not differ among patients undergoing DM and conventional THA; DM THA in particular was not associated with a higher risk of groin pain, despite its comparatively larger femoral head sizes. HR, on the other hand, was associated with a higher risk of pain. Appropriate implant sizing and bearing couple choice may optimize the functional benefit of THA.
腹股沟疼痛是全髋关节置换术（THA）常见的长期并发症。股骨头大小被认为是主要原因之一。双动（DM）THA中使用的植入物具有较大的外承重关节，这可能会增加术后腹股沟疼痛的风险。髋关节表面置换术（HR）也已被证明与腹股沟疼痛风险相关。
问题/目的：本研究的目的是比较不同股骨头直径的患者以及接受传统THA、DM THA和HR的患者在髋关节置换术后1年时腹股沟疼痛的发生率。
在梳理了因原发性髋关节骨关节炎接受THA或HR的所有患者的机构登记资料后，我们纳入了3193例患者进行分析；2008例接受传统THA，416例接受DM THA，769例接受HR。我们使用逻辑回归模型分析术后1年腹股沟疼痛与患者人口统计学和临床特征之间的关系，这些特征包括年龄、性别、体重指数（BMI）、术后1年的加州大学洛杉矶分校活动评分、承重配对以及髋臼直径与股骨头直径的比值。我们还在术后1年对有和没有腹股沟疼痛的部分患者测量了髋臼倾斜度和前倾角，以评估疼痛是否可能与植入物位置有关。
总体而言，8.7%的患者在术后1年报告有腹股沟疼痛。有腹股沟疼痛的患者更年轻，BMI更低。髋臼与股骨头比值越大，腹股沟疼痛的几率越高，不过有趣的是，DM植入物与腹股沟疼痛并无显著关联；这可能是因为它们的大部分运动都在植入物内部进行。测量髋臼倾斜度和前倾角的亚组分析显示，有疼痛和无疼痛的患者之间髋臼位置没有差异。
在这群髋关节置换患者中，接受DM THA和传统THA的患者术后1年腹股沟疼痛的发生率没有差异；特别是DM THA与腹股沟疼痛风险较高无关，尽管其股骨头尺寸相对较大。另一方面，HR与较高的疼痛风险相关。选择合适的植入物尺寸和承重配对可能会优化THA的功能效益。
